| NPI | 1720191133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556502) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010479) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2007-12-19 |